The treatment of somatization: teaching techniques of reattribution

Patients commonly present to general practitioners with somatic symptoms for which no adequate physical cause can be found, which are accompanied by the symptoms of an anxiety state or a depressive illness. These illnesses pose a major public health problem, but little is known about optimal management. A three stage model is proposed to encourage patients to reattribute these symptoms, and relate them to psychosocial problems. These stages are; feeling understood; changing the agenda; and making the link. A videotaped learning package is described suitable for use with vocational trainees in general practice, consisting of demonstrations of component parts of the model followed by micro-teaching, as a preliminary to video-feedback of actual interviews with such patients.